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PANRE > EENT 9% > Flashcards

EENT 9% Flashcards

1
Q

Eyelid changes: crusting, greasy, scaling, red-rimming of eyelid and eyelash, flaking along with dry eyes and associated seborrhea and rosacea

A

Blepharitis

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2
Q

History of blunt trauma, muscle entrapment, eyelid swelling, gaze restriction, double vision, decreased visual acuity, enophthalmos (sunken eye).

A

Blowout fracture

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3
Q

Blowout fracture: anesthesia/paresthesia in the gums, upper lips, and cheek due to damage to the ______ nerve

A

infraorbital

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4
Q

Blurred vision over months or years, halos around lights.

A

Cataract

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5
Q

Clouding of the lens =

Clouding of cornea =

A

Cataract; glaucoma

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6
Q

Cataract treatment

A

Fundoscopy: “black on red background.”

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7
Q

A sterile painless (non-infectious) granuloma of the internal meibomian sebaceous gland, painless “cold” lid nodule

A

Chalazion

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8
Q

Copious watery discharge, scant mucoid discharge.

A

Viral conjunctivitis

Adenovirus (most common). Self-limiting associated with URI.

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9
Q

Pt presents with purulent (yellow) discharge, crusting, usually worse in the morning. May be unilateral.

A

Bacterial conjunctivitis

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10
Q

Acute mucopurulent conjunctivitis

A

S. pneumonia, S. aureus

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11
Q

Copious purulent discharge, in a patient who is not responding to conventional conjunctivitis treatment

A

M. catarrhalis, Gonococcal

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12
Q

Conjunctivitis in newborn; scant mucopurulent discharge; giemsa stain - inclusion body.

A

Chlamydia

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13
Q

Red eyes, itching and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid.

A

Allergic conjunctivitis

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14
Q

Sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection.

A

Corneal abrasion

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15
Q

Corneal abrasion diagnosis; treatment

A

Fluorescein dye - increased absorption in devoid area.

Antibiotic eye ointment, no patching.

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16
Q

Contact lense wearers; caused by deep infection in the cornea by bacteria, viruses or fungi.

A

Corneal ulcer

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17
Q

Corneal ulcer findings; testing

A

White spot on surface of cornea that stains with fluorescein: round “ulceration” versus “dendritic” pattern like herpes

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18
Q

Inflammation of the nasolacrimal duct or the nasolacrimal gland (supratemporal);
Infectious obstruction of nasolacrimal duct (inferomedial region)

A

Dacryoadenitis

Dacryocystitis

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19
Q

Eversion of the eyelid; occurs when the eyelid turns outward exposing the palpebral conjunctiva; conjunctiva will appear red from air exposure and inflammation

A

Ectropion

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20
Q

Inversion of an eyelid; occurs when the eyelid turns inward; cause; treatment.

A

Entropion.

Most commonly caused by age-related tissue relaxation. Surgical correction is definitive

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21
Q

Ocular foreign body treatment; possible sequella

A

Irrigation and removal with sterile swab.
Intraocular foreign bodies require immediate surgical removal by an ophthalmologist.
Metallic foreign bodies may leave a rust ring.

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22
Q

Ocular aqueous outflow obstruction, most common, > 40 y/o, African Americans, often asymptomatic, peripheral to central gradual visual loss (versus macular degeneration which is central loss)

A

Open angle glaucoma

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23
Q

Acute angle closure glaucoma signs/symptoms

A

Iris against lens, dark environment, acute loss of vision, nausea, and vomiting. Classic triad: injected conjunctiva, steamy cornea, and fixed dilated pupil; this is an ophthalmic emergency.

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24
Q

Painful, warm (hot), swollen red lump on the eyelid (different from a chalazion which is painless); cause

A

Hordeolum
Think “H” for Hot = Hordeolum.
Most common organism S. aureus.

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25
Q

Trauma causes blood in the anterior chamber of the eye (between the cornea and the iris). The blood may cover part or all of the iris (the colored part of the eye) and the pupil, and may partly or totally block vision in that eye.

A

Hyphema

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26
Q

Hyphema treatment

A

Treat with eye protection and rest with the head of the bed at 30 degrees all the time.

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27
Q

Gradual painless loss of central vision. The macula is responsible for central visual acuity which is why macular degeneration causes gradual central field loss. Metamorphopsia (distortion on Amsler grid)

A

Macular degeneration

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28
Q

Atrophic changes with age – slow gradual breakdown of the macula (macular atrophy), with Drusen (yellow retinal deposits).

A

Dry macular degeneration (85% of cases)

Drusen = Dry

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29
Q

Hemorrhage, neovascuration. New abnormal vessels grow under central retina which leak and bleed causing retinal scarring.

A

Wet macular degeneration

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30
Q

Rapid involuntary eye movement

A

Nystagmus

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31
Q

Most common and often benign nystagmus

A

Gaze-evoked

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32
Q

Down/upbeat nystagmus etiology

A

CNS dysfunction

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33
Q

Vestibular (horizontal) nystagmus etiology

A

Labyrinth or vestibular nerve dysfunction

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34
Q

Acute inflammation and demyelination of the optic nerve leading to acute monocular vision loss/blurriness and pain on extraocular movements. Typically occurs over hours or days. Associated with multiple sclerosis.

A

Optic neuritis

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35
Q

Optic neuritis fundoscopy findings

A

Inflammation of the optic disc

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36
Q

Decreased extraocular movement, pain with movement of the eye and proptosis, signs of infection. Often associated with sinusitis. Occurs more often in children than adults.

A

Orbital cellulitis

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37
Q

Orbital cellulitis treatment

A

Hospitalization and IV broad-spectrum antibiotics.

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38
Q

Optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks.

A

Papilledema

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39
Q

Papilledema causes

A

Brain tumor/abscess, meningitis, cerebral hemorrhage, encephalitis, pseudotumor cerebri.

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40
Q

Papilledema testing; treatment

A

Immediate neuroimaging to rule out mass lesion, then
CSF analysis.
Treat underlying cause.

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41
Q

Elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in inner corner/nasal side of the eye). Treatment.

A

Pterygium

Only surgically remove when vision is affected

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42
Q

Vertical curtain coming down across the field of vision, may sense floaters or flashes at onset, loss of vision over several hours. Asymmetric red reflex.

A

Retinal detachment

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43
Q

Retinal detachment treatment

A

Consult ophthalmologist. Stay supine (lying face upward) with head turned towards the side of the detached retina.

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44
Q

Sudden, painless, unilateral, and usually severe vision loss (Amaurosis fugax).

A

Retinal vascular occlusion

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45
Q

Retinal vascular occlusion etiologies

A

Embolism from the same side (ipsilateral) carotid artery, ophthalmic artery, or heart, or giant cell arteritis.

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46
Q

Retinal vascular occlusion testing

A

Rule out carotid artery stenosis by carotid ultrasound. Look for the cherry red spot.

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47
Q

Retinopathy

A

Leading cause of blindness, most common is diabetic retinopathy. Proliferative type is most severe.

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48
Q

Retinopathy funduscopic exam

A

Cotton wool spots, hard exudates, blot and dot hemorrhages, neovascularization, flame hemorrhages, A/V nicking

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49
Q

Any form of ocular misalignment

A

Strabismus

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50
Q

Strabismus test

A

Cover/uncover test

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51
Q

Exotropia; esotropia

A

Out-turning of eyes; in-turning of eyes.

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52
Q

Strabismus treatment

A

Patch exercises, if untreated after age two, amblyopia results.

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53
Q

Acute/chronic otitis media findings

A

Age 2 and under, limited mobility of the TM with pneumotoscopy.

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54
Q

Acute/chronic otitis media organisms

A

S. pneumoniae 25%, H. influenzae 20%, M. catarrhalis 10%

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55
Q

Acute/chronic otitis media treatment

A

First line Amoxicillin.

Second line Augmentin; macrolides if pen allergic

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56
Q

Acute/chronic otitis media complications

A

Mastoiditis and bullous myringitis.

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57
Q

Benign tumor of the Schwann cells (the cells which produce myelin sheath) – most commonly affects the vestibular division of the 8’th cranial nerve.

A

Acoustic neuroma

58
Q

Acoustic neuroma symptoms

A

Slowly progressive unilateral hearing loss, tinnitus, disequilibrium.

59
Q

Acoustic neuroma diagnosis and treatment

A

Diagnose with MRI.

Treat with surgery or stereotactic radiation therapy

60
Q

Barotrauma presentation

A

Ear pain and hearing loss that persists past the inciting event, associated with pressure changes.
Common injury in divers or while flying; sudden onset of pain that may resolve with a “pop.”

61
Q

Cholesteatoma

A

Painless otorrhea, brown/yellow discharge with strong odor, caused by chronic eustachian tube dysfunction which results in chronic negative pressure and inverts part of the TM causing granulation tissue that over time, erodes the ossicles and leads to conductive hearing loss. Surgical removal.

62
Q

Ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, fluctuating conductive hearing loss, tinnitus.

A

Eustachian tube dysfunction.

All children < 7 years old have some ET dysfunction (based on the angle of the ET); will resolve with age

63
Q

Foreign body in ear treatment

A

Insects must be immobilized prior to removal. Drown insects with mineral oil or viscous lidocaine before attempting removal. After irrigation, if the child is uncomfortable, consider treating with topical pain agents such as benzocaine-antipyrine

64
Q

Most common causes of hearing impairment/loss

A

Cerumen impaction, eustachian tube dysfunction (secondary to upper respiratory tract infection [URI]), and increasing age (presbycusis)

65
Q

Hearing impairment Weber test

A

Tuning fork is placed on center of the head and see if sound lateralizes: Sound lateralizes to affected ear in conductive hearing loss; sound lateralizes to unaffected ear in sensorineural hearing loss

66
Q

Hearing impairment Rinne test

A

Tuning fork placed on mastoid and then up to the ear (should continue to hear) conductive hearing loss if bone > air, sensorineural hearing loss if air > bone

67
Q

Blunt trauma to ear shearing forces to the anterior auricle lead to separation of the anterior auricle perichondrium from the underlying cartilage. May result in thickening of cartilage (cauliflower ear) if not treated promptly! .

A

Hematoma of the external ear.

Evacuate blood and cephalexin

68
Q

Acute onset, vertigo + hearing loss, tinnitus of several days to a week. Usually viral, absence of neurologic deficits.

A

Labyrinthitis

69
Q

Labyrinthitis etiology

A

Usually viral

70
Q

Labyrinthitis treatment

A

Diazepam or meclizine for vertigo, promethazine for nausea

71
Q

Complication of acute otitis media. Fever, otalgia, pain & erythema posterior to the ear, and forward displacement of the external ear.

A

Mastoiditis

72
Q

Mastoiditis organisms

A

S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes.

73
Q

Mastoiditis treatment

A

IV antibiotics (ceftriaxone), drainage of middle ear fluid.

74
Q

Vertigo attacks lasting hours.

Classic triad of low-frequency hearing loss, tinnitus with aural (ear) fullness and vertigo

A

Meniere’s disease

75
Q

Meniere’s disease treatment

A

Low salt diet, diuretics (HCTZ + triamterene) to reduce aural pressure

76
Q

Otitis externa presentation

A

Edema with cheesy white discharge, palpation of the tragus is painful

77
Q

Otitis externa organisms

A

Pseudomonas aeruginosa (swimmer’s ear), S. aureus (digital trauma)

78
Q

Malignant otitis externa is commonly seen in _______

A

Diabetics

79
Q

Tinnitus

A

Perceived sensation of sound in the absence of an external acoustic stimulus; often described as a ringing, hissing, buzzing, or whooshing.

80
Q

Tinnitus etiologies

A

90% is associated with sensorineural hearing loss – caused by loud noise, presbycusis, medications (aspirin, antibiotics, aminoglycosides, loop diuretics and CCBs), Meniere’s disease, acoustic neuroma.

81
Q

Tympanic membrane perforation sign/symptoms

A

Pain, otorrhea, and hearing loss/reduction

82
Q

Tympanic membrane perforation treatment

A 
Keep clean and dry, treat with antibiotics - the only class of antibiotics that are non-ototoxic are Floxin drops. 
Surgery if persists past 2 months.
83
Q

Central vertigo

A

More gradual onset and vertical nystagmus. Unlike peripheral vertigo, it does not present with auditory symptoms. Romberg Sign.

84
Q

Central vertigo etiologies

A

Brainstem vascular disease, arteriovenous malformations, tumors, multiple sclerosis, and vertebrobasilar migraine.

85
Q

Peripheral vertigo (inner ear)

A

Sudden onset, nausea/vomiting, tinnitus, hearing loss, and horizontal nystagmus.

86
Q

Peripheral vertigo (inner ear) etiologies

A

Labyrinthitis, benign paroxysmal positional vertigo, endolymphatic hydrops (Ménière’s syndrome), vestibular neuritis, and head injury.

87
Q

Benign Positional Vertigo diagnosis/treatment

A

Dix-Hallpike maneuver; Epley’s maneuver

88
Q

Sinus pain/pressure (worse with bending down and leaning forward). After URI. Facial tap elicits pain.

A

Acute and chronic sinusitis

89
Q

Sinusitis, viral, symptoms

A

Most common, symptoms < 7 days

90
Q

Sinusitis, bacterial, symptoms

A

Symptoms 7+ days and associated with bilateral purulent nasal discharge.

91
Q

Sinusitis, bacterial, organisms

A

S. pneumoniae, H. influenzae, M.catarhalis.

92
Q

Sinusitis treatment

A

Indications for antibiotics in rhinosinusitis include duration of symptoms >10 days without improvement, Augmentin 875 BID, kids Amoxicillin x 10-14 days.

93
Q

Chronic sinusitis testing

A

Plainview X-ray (waters view) is a good initial screening, CT is the gold standard.

94
Q

Allergic rhinitis

A

Clear nasal drainage, pruritus, pale, bluish, boggy mucosa, allergic shiners, IgE mediated mast cell histamine release

95
Q

Allergic rhinitis treatment

A

Intranasal decongestants not to be used more than 3-5 days; may cause rhinitis medicamentosa

96
Q

Epistaxis anterior source

A

Kiesselbach’s Plexus or Little’s Area is the most common site

97
Q

Epistaxis posterior source

A

Shenopalatine artery (Woodruff’s plexus) is generally the source of severe posterior nosebleed

98
Q

Epistaxis treatment

A

Direct pressure for 15 minutes, posterior balloon packing is used to treat posterior epistaxis

99
Q

Purulent, foul-smelling nasal discharge

A

Nasal foreign body

100
Q

Teardrop-shaped growths that form in the nose or sinuses, usually benign, associated with allergic rhinitis.

A

Nasal polyps

101
Q

Samter’s triad

A

Aspirin sensitivity, Asthma, and nasal polyps.

102
Q

When multiple polyps are seen, consider _______

A

Cystic Fibrosis

103
Q

Acute pharyngitis etiologies

A

Viral - Adenovirus (most common), mononucleosis, Group A Streptococcus, Neisseria gonorrhea, fungal

104
Q

Mononucleosis etiology, sign/symptoms, testing

A

Epstein Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes, + heterophile agglutination test (monospot).

105
Q

Mononucleosis precautions

A

Symptomatic and avoid contact sports. Antibiotics such as amoxicillin or ampicillin may cause a rash.

106
Q

In patients with recent sexual encounters, or with non-resolving pharyngitis consider _________

A

Gonorrhea pharyngitis

107
Q

Acute pharyngitis in patients using inhaled steroids consider _________

A

Fungal causes

108
Q

Centor Criteria; increased likelihood of _________

A

Absence of cough, exudates, fever, cervical lymphadenopathy.
Group A Streptococcal pharyngitis: S. pyogenes.

109
Q

Acute pharyngitis testing

A

Throat culture is gold standard

110
Q

Strep pharyngitis treatment

A

Penicillin is first line, Azithromycin if Pen allergic.

111
Q

Strep pharyngitis complications

A

Rheumatic fever and post-strep glomerulonephritis.

112
Q

Aphthous ulcers

A

Single or multiple small, shallow ulcers with yellow-gray fibrinoid center with red halos

113
Q

Aphthous ulcer testing

A

Biopsy should be considered for ulcers lasting more than 3 weeks

114
Q

Aphthous ulcer treatment

A

Viscous lidocaine 2–5% applied to ulcer QID after meals until healed

115
Q

Gingivitis risk

A

Increases risk for cardiovascular events

116
Q

Gingival hyperplasia; etiologies

A

Overgrowing of gums so that it blocks the teeth, commonly caused by medications. phenytoin, CCB’s and cyclosporine

117
Q

Vincent’s angina

A

“Trench Mouth” - necrotizing gingivitis: characterized by the “punched-out” ulcerative appearance of the gingival papillae

118
Q

Dental abscess etiology; risk; treatment

A

Poor dental health is a risk factor for dental abscess or facial cellulitis, treat with IM ceftriaxone and amoxicillin

119
Q

Unvaccinated patient leaning forward, drooling, stridor and distress (tripod position, muffled voice)

A

Epiglottitis

120
Q

Epiglottitis etiology

A

H. influenza type B (Hib)

121
Q

Epiglottitis diagnosis; treatment

A

Lateral radiograph: Thumbprint sign.

Secure airway, IV Ceftriaxone, and IV fluids.

122
Q

Laryngitis

A

Almost always viral, hoarseness following a URI

123
Q

Laryngitis > 2 weeks, history of ETOH and/or smoking, consider _________

A

Squamous cell carcinoma

124
Q

Laryngitis symptoms persisting > 3 weeks, then _____

A

laryngoscopy

125
Q

Oral Candidiasis presentation

A

Immunocompromised, young patients. Painful, white fluffy patches that can be scraped off and may bleed when scraped (candidiasis can “come off”), leaving an erythematous, friable base.

126
Q

Oral candidiasis test

A

Diagnose with potassium hydroxide (KOH) prep

127
Q

Oral herpes simplex presentation

A

Prodromal period of tingling discomfort or itching, vesicular lesions all in the same stage of development, HSV type 1

128
Q

Painless, precancerous white lesions on the side of the tongue that cannot be scraped off

A

Oral leukoplakia

129
Q

Oral leukoplakia predispositions

A

Smokers, AIDs, alcohol abuse

130
Q

Hot potato (muffled) voice and deviation of the uvula to one side

A

Peritonsillar abscess

131
Q

Parotitis; etiology; in adult males consider associated _______

A

Mumps; Paramyxovirus; orchitis

132
Q

Acute swelling of the cheek, which worsens with meals.

A

Sialadenitis [think salad = salivary]

133
Q

Sialadenitis etiology

A

Infection of a salivary gland (S. aureus) usually caused by sialolithiasis (obstructing stone) in the salivary gland.

134
Q

Sialadenitis diagnosis

A

CT, ultrasonography, or MRI

135
Q

Thyroid neoplastic disease, most common type

A

Papillary. See endocrinology.

136
Q

Oral Cancer: Most often ______ secondary to the use of __________ and account for up to ___ percent of cases of _______ of the head and neck

A

Squamous cell carcinoma; tobacco and alcohol; 80; squamous cell carcinoma

137
Q

Cyst appearing after URI anterior to sternocleidomastoid; most common lateral neck mass

A

Branchial cleft cyst

138
Q

Hyoid or sub-hyoid soft mass which rise with tongue protrusion; most common midline neck mass

A

Thyroglossal duct cyst

139
Q

Unilateral, painless, persistent cervical lymphadenopathy consider _____

A

lymphoma; see hematology

140
Q

White oral lesion that is painless and cannot be rubbed or scraped off. Often linked with tobacco, alcohol, or denture use.

A

Leukoplakia

141
Q

Leukoplakia: 5% are ____________

A

Dysplastic or squamous cell carcinomas

PANRE (9 decks)

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